title: Monitoring circulating epithelial tumour cells (CETC) to gauge therapy: in patients with disease progression after trastuzumab persisting CETC can be eliminated by combined lapatinib treatment.
abstract: BACKGROUND
  In breast cancers, the gene for the growth factor receptor HER2 can be amplified leading to increased aggressiveness and metastasis formation. The monoclonal antibody trastuzumab prolongs relapse-free survival highly significantly but eventually many patients relapse.
  
  
  METHODS
  In this study, CETC were monitored using the Maintrac method during adjuvant trastuzumab treatment and during subsequent treatment with capecitabine/lapatinib.
  
  
  RESULTS
  In one patient, trastuzumab led to marginal reduction in CETC with disease progress. The combination of capecitabine/lapatinib was preliminarily capable to eliminate all CETC, however, CETC reappeared. The second patient received adjuvant taxane together with trastuzumab and 1 year of further trastuzumab during which CETC increased. After stopping trastuzumab skin metastases occurred. Capecitabine/lapatinib led to complete CETC elimination with stable disease.
  
  
  CONCLUSIONS
  In patients with lack of CETC reduction in spite of trastuzumab treatment correlated with disease progression the combination of capecitabine/lapatinib highly efficiently led to rapid elimination of CETC warranting further monitoring during such studies.
authors.affiliation: Women's Hospital, Friedrich Schiller University, Bachstr. 18, 07740, Jena, Germany.
authors.forename: Oumar
authors.initials: O
authors.lastname: Camara
authors.forename: Cornelia
authors.initials: C
authors.lastname: Jörke
authors.forename: Ulrike
authors.initials: U
authors.lastname: Hammer
authors.forename: Anne
authors.initials: A
authors.lastname: Egbe
authors.forename: Carola
authors.initials: C
authors.lastname: Rabenstein
authors.forename: Ingo B
authors.initials: IB
authors.lastname: Runnebaum
authors.forename: Klaus
authors.initials: K
authors.lastname: Hoeffken
authors.forename: Katharina
authors.initials: K
authors.lastname: Pachmann
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001773:Blood Cells / Q000187:drug effects / Q000473:pathology*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018450:Disease Progression; D004847:Epithelial Cells / Q000187:drug effects / Q000473:pathology*; D005260:Female; D005784:Gene Amplification; D006801:Humans; D000077341:Lapatinib; D008991:Monitoring, Physiologic / Q000379:methods; D011799:Quinazolines / Q000627:therapeutic use*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000077341:Lapatinib; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab